Virginia Panconi, left, and Helen Reasch chat on the van that will take them to Providence ElderPlace, which provides medical care and a gathering place.

Virginia Panconi, left, and Helen Reasch chat on the van that will take them to Providence ElderPlace, which provides medical care and a gathering place.

Photo: Grant M. Haller/Seattle Post-Intelligencer

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Wanda Veal, personal care assistant coordinator, takes Geraldine Jacobsen for a dance at Providence ElderPlace. Staff members dance with participants before they leave the center.

Wanda Veal, personal care assistant coordinator, takes Geraldine Jacobsen for a dance at Providence ElderPlace. Staff members dance with participants before they leave the center.

Photo: Grant M. Haller/Seattle Post-Intelligencer

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Virginia Panconi, 73, works on building up her arm strength at the center. The care provided there has enabled her to avoid remaining in a nursing home and to live in an apartment near her daughter.

Virginia Panconi, 73, works on building up her arm strength at the center. The care provided there has enabled her to avoid remaining in a nursing home and to live in an apartment near her daughter.

Photo: Grant M. Haller/Seattle Post-Intelligencer

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ElderPlace gives seniors one-stop medical shop

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As 9 a.m. approaches, Virginia Panconi gently places plastic tubing under her nose and over her ears.

She listens for the click that tells her oxygen is flowing from the tank she stows in her walker, then heads down to the lobby of her Seattle Housing Authority apartment building in White Center. The 73-year-old woman with heart problems joins 10 other people, four wheelchairs and six walkers for the 25-minute van ride to Rainier Valley.

They're headed to the Providence ElderPlace center. It's a place where Medicare and Medicaid recipients receive the bulk of their medical care. A place where they socialize and exercise. A place that keeps people such as Panconi out of nursing homes.

Providence ElderPlace is one of 39 PACE-style programs nationally -- an acronym that stands for Program of All-inclusive Care for the Elderly -- and the only such program in Washington state.

Participants sign over management of their Medicare and Medicaid benefits to the program, and Providence ElderPlace accepts a flat per-person monthly payment. Participants get a comprehensive battery of services, from primary care to physical therapy, from optometry to drugs, from transportation to recreation.

Since 1995, Providence ElderPlace's 8,000-square-foot building in Rainier Valley has housed administrative offices, a pharmacy, examining rooms, a kitchen, a physical therapy area, a multipurpose room and a couple of conference rooms.

The space crunch will ease when ElderPlace moves into a new building planned for the redeveloped Rainier Vista housing complex. The Bill & Melinda Gates Foundation gave a $350,000 matching grant to help pay for the lease on the new center, which is 50 percent larger than the current one.

The program has about 185 participants, but the new building will accommodate between 350 and 400.

PACE programs have been around for more than three decades, but it wasn't until 1997 that Congress made them a recognized provider type under Medicare and Medicaid.

Participants give up the freedom of choosing their own doctors but gain a full range of care offered in one location. "It's completely coordinated and all-inclusive in this building," said Dr. Terry Rogers, the program's medical director. "Outside, it's all partitioned, it's piecemeal."

The hope is that they also gain the preventive care and living assistance that keeps them out of nursing homes. For Panconi, that translates into a critical sense of independence.

"I think feeling independent is important when you're my age," said Panconi, who has a tendency to bow her head forward and gaze up pointedly through her dark wire-rimmed glasses. "The things that they do for me I know I need, but I don't want to need them sometimes."

Panconi's daughter, Linda Davis, found Providence ElderPlace last year, when her mother was getting well enough to leave the nursing home she had been in for about a year, sent there by heart problems and fainting episodes. Panconi's finances were exhausted, and she was sick of the facility that she describes as "unattractive," to put it nicely.

"Trying to find an assisted care facility that accepted Medicaid turned out to be not an easy process," said Davis, 51, an air-freight carrier administrator who lives in West Seattle.

Providence ElderPlace contracts with the Seattle Housing Authority for apartments and places assistants in the buildings to help out with cooking, cleaning, bathing, shopping -- whatever program participants need. This is how Panconi found the subsidized apartment in White Center, less than 10 minutes from her daughter's home.

Davis and Panconi give Providence ElderPlace high marks for the quality of care and the staff.

"It far exceeds anything we've experienced in this kind of assisted care setting," Davis said. "I'm just really pleased with all aspects of the program they offer."

The ElderPlace center is a gathering place for care providers as well as program participants. An interdisciplinary team of doctors, nurses, social workers, rehabilitation staff, home care aides and others meet regularly to discuss the needs of patients. It makes for pretty close monitoring, which makes for fewer emergency room visits and keeps patients out of nursing homes longer.

Of the 184 participants, who are enrolled in the program for life, only 5 percent are in nursing homes.

The PACE program grew out of an initiative in San Francisco's Chinatown and North Beach neighborhoods. With a growing elderly population, the community there started looking for ways to care for the elderly without building a prohibitively expensive and culturally unacceptable nursing home.

Out of that grew a community-based care system based on the British day hospital model was named On Lok Senior Health Services, Cantonese for "peaceful, happy abode."

The first day center opened in San Francisco 1973. Thirteen years later, the Robert Wood Johnson Foundation funded six additional demonstration projects, and based on their success, Congress in 1997 made PACE a permanent Medicare/Medicaid option.

The Providence ElderPlace program opened its doors in October 1995. In January 1999, the program added assisted-living housing units, and last year ElderPlace became a permanent PACE provider.

The program is open to anyone over 55 in most of King County who needs "nursing facility care" as defined by the state of Washington. In reality, though, nearly all the participants at Providence ElderPlace are on Medicaid. The average age is 78, and most participants have multiple chronic health problems: diabetes, heart disease, respiratory illnesses.

Along with providing a model of care designed to be comprehensive and money-saving, Providence ElderPlace is taking care of many elderly people with few other options.

"This is a population of people that nobody else wants," Rogers said. "You talk about your standard Medicare HMOs, they don't want people like this."